UW Health, Madison

UW Health formed a multidisciplinary team to develop a pilot program for one medical and one surgical inpatient unit. Using a plan-do-check-act (PDCA) quality improvement process, the team accomplished the following:
 

• Identified best practices for 4Ms currently being utilized on pilot units and looked for ways to optimize gaps in care
• Developed discipline-specific education about the 4Ms
• Created a 4Ms nursing flowsheet within Health Link, including a patient section expanded to include “What Matters” 
• Developed interactive dashboard to evaluate the 4Ms structure
• Sought multi-disciplinary feedback
• Created a new patient informational form based on RN feedback 
• Utilized an interactive dashboard to monitor 4Ms implementation
• Continue PDCA cycles to refine flowsheets and workflow based on champion and user feedback

Looking more closely at “What Matters,” patients are now regularly asked about what is most important to them in terms of:
 

• Clinical Care Needs: Physical needs, mental health needs, medications, etc.
• Comfort: Ease from pain, emotional, physical distress; feeling valued and cared for
• Family Connections: Relationships with family and significant others
• Understanding Their Plan of Care: Patients’ understanding of their condition and interventions that are being done in the hospital

In addressing “Mentation,” UW Health chose to focus on the care of the patient with dementia. The result is the development of a unique evidence-based care assessment, “Patient-Specific Dementia Information,” which provides staff with easily accessible information in Health Link regarding individual patient’s cognitive/functional baseline, behaviors and social history. This can be used to inform assessments, individualize the patient’s plan of care and improve continuity of care and transitions across settings. 

UW Health has expanded these Age-Friendly care practices to their East Madison Hospital and will continue to expand across the UW Health inpatient settings. Of note, in 2022 UW Health received a grant from Bader Philanthropies in collaboration with the UW School of Nursing to support the spread and optimization of Age-Friendly care. Future evaluation will determine the impact of the 4Ms interventions on patient outcomes, including delirium incidence and length of stay.